Psychological and Physical Addiction: A simplistic misconception?

[Dickon]

Although I have found a couple of threads discussing what is addiction, they have both died a death, and there's a specific issue I'd like to start a discussion about. In the amphetamines addiction and recovery section someone asked "are amphetamines addictive?", to which I gave the unusually brief reply: "Is the Pope Catholic?" Of course they fucking are!

The trouble is, if you ask me, people are hung up on the idea that there are two fundamentally different types of addiction: the physical and the psychological, and somehow the latter are really only in one's head, so stop whining and get on with life. I've seen this kind of post when it comes to amphetamines and I think it's not only exceeding unhelpful to someone trying to quit, I further think it's out and out wrong.

My cat has experience of various "addictive" substance used in an addictive way: essentially opiates (heroin, morphine, methadone etc.), benzodiazepines (diazepam/Valium, xanax/Alprazolam etc), alcohol, amphetamines, (crack) cocaine, nicotine and caffeine. He also went through a period of using cannabis on a daily basis, brief periods of nitrous oxide use, and took a fair whack of LSD. He also sniffed glue and other solvents, and took barbiturates, although never for extended periods.

What can I report back on his behalf? Clearly some have experienced pets (to a greater of lesser extent). Such owners can form their own opinions, and to my view such experience is invaluable. However, it might also be a hindrance in that it leads to a vastly subjective point of view. I need only remember a friend of mine taking just one toke from a crack pipe to realise we are not all the same.

But what of addiction? Opiates are one of the classically "physically addictive" drugs. But if we stop a minute and think, the withdrawal symptoms are caused by a lack of sufficient endorphins to fit the receptors in the brain. This occurs entirely inside one's head. So, if it is a physical problem it is one limited in scope to the brain (we shall ignore the peripheral opiate receptors in the gut and perhaps others. This is a minor issue). The somatic manifestations (i.e. gooseflesh, flu-like symptoms etc) are caused by disfunctional brain function not the other way round. So, neurons fire in an off-whack sort of way due to a chemical "imbalance" in the brain.

Let us now look at a "psychologically addictive" drug: classic examples are the stimulants. Here we are dealing with dopaminergic drugs, that cause dopamine to be released, or inhibit the reuptake of dopamine. When these are stopped, at least after long term use the dopamine system in the brain is screwed up and long-term depression, somnolence, apathy, suicidal ideation, over-eating, are among the resultant effects. Perhaps imbalance in this system of the brain doesn't lead to much overt change in the rest of the body, but stimulant users do tend to have a remarkably hard time quitting, and staying quit.

Benzodiazepine use and withdrawal affects the GABA system. Here the fits that withdrawal can cause manifest physically, but the reason there are physical manifestations are because the electrical activity of the brain (i.e. the mind or psyche in some broad sense, without making philosophical distinctions) is yet again out of whack.

Cannabis affects the endogenous cannabinoid receptor system I'd imagine, and some seem to have a great difficulty stopping that. Nicotine is often quoted as being "physically addictive", but how so? There is no "gooseflesh". alcohol seems to be addictive long before there are any physical withdrawal symptoms. Caffeine has the physical withdrawal symptom of, wait for it, headaches: oh no, that's all in the head. How confusing!

All in all my cat tells me each substance has its own flavour of addictiveness, and this flavour can act on different individuals in different ways. There is no way my cat could smoke crack, shoot, smoke or eat amphetamines, and not take more if available. At that point the brain is out of whack (again!). My cat seems to experience two distinct phases to stimulant "withdrawal". The first is the overwhelming craving associated with not having the drug, for an hour or several in the case in the case of crack, and for a day or several in the case of amphetamines. This is followed by more chronic depression, sleepiness, apathy, cravings etc.

Why do so many people start using opiates once the "physical withdrawals" are over?

Well, I don't have all the answers, but I feel strongly that by thinking about addiction in the physical/psychological sense, we are missing the point, and missing the very real physical and long-term changes in brain chemistry that almost certainly occur with long-term use and cessation of almost any psychoactive substance. Any so-called physical withdrawal symptoms are consequences of the particular nature of the imbalance in brain chemistry caused by cesation of the drug in question. As far as I know the drugs with dangerous withdrawals are those for which the brain has the greatest short-term difficulty re-establishing equilibrium, to the extent that homeostasis can't occur and death follows.

Oddly, and I doubt I'd be talking purely hypothetically here, a drug that could be used in greater and greater quantities to regulate, say, liver function, but that upon abrupt withdrawal would throw the liver so off kilter that physical manifestations would occur is unlikely to be considered addictive by most standards.

What does the rest of DF think?

Dickon

Reputation Comments on this post:

	Great topic, I'd love to see an intelligent conversation or even debate on this subject
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